Mapping Genetic Risk of Suicide

1. Mapping Genetic Risk of Suicide Virginia Willour, Ph.D.

2. Suicidal Behavior • Suicidal behavior is a complex phenotype that includes both attempted and completed suicide • Family, twin, and adoption studies provide strong evidence for a heritable component to suicidal behavior • The heritable component for suicidal behavior depends on • Strong association with psychiatric disorders, especially mood disorders • Independent heritable factors, such as tendency towards impulsive aggression, have also been suggested • Under a two-hit hypothesis, individuals with a psychiatric disorder and a tendency towards impulsive aggression are at greatest risk for suicidal behavior

3. Suicide Genetic Research • Unlike some other complex genetic disorders, suicide research is still in its infancy • To date, neurobiologic and genetic studies of suicidal behavior have focused mostly on the serotonergic system • Environmental risk factors, such as parental abuse and early parental loss, may also interact with genetic factors and increase risk • The biggest challenges today in suicide research include educating the public about the complex nature of the behavior and identifying compelling candidate genes and biological pathways to study in depth

4. Genetic Risk Factors • We anticipate that the genetic component for • suicidal behavior may be due to genetic variation • in many genes, each with a small effect • These genes may cluster in biological pathways • related to brain functioningand development • Alternately, these genes could directly influence • personality characteristics, such as impulsivity, • aggressiveness, or neuroticism

5. Two complementary strategies for identifying genes influencing suicidal behavior The human genome: 23 pairs of chromosomes • Serotonergic Pathway • Genome-wide • Association Study

6. Serotonin and Suicide • The serotonergic system was initially • implicated in the etiology of suicidal • behavior by the finding of lowered • levels of the serotonin metabolite • 5-HIAA in the CSF of patients who • attempted suicide, especially by • violent means. • The importance of the serotonergic • system in suicidal behavior is now • supported by multiple lines of • investigation, including • Postmortem brain studies • Pharmacological studies • Genetic studies of suicidal behavior • have also focused on the serotonergic • system, with inconsistent results. 3-D model of serotonin structure (3DChem.com)

7. Genetic Association Studies • The goal of our serotonin • association study was to • investigate the patterns of • genetic variationinattempted • suicide for 17 genes • from the serotonin pathway • The 17 genes included • Serotonin transporter • MAOA • Tryptophan hydroxylase genes • 13 serotonin receptor genes • Tested DNA samples from subjects • with and without a history of • suicide attempts

8. Enzymes 5HT synthesis Enzyme 5HT degradation HTR1D HTR1B HTR3B HTR7 HTR5A HTR1A HTR1D HTR3A HTR1A HTR2C HTR2B HTR1E HTR1B HTR4 HTR6 SLC6A4 HTR2A MAOA TPH2 TPH1 5HT 5HT 5HT 5HT 5HT 5HT 5HT 5HT 5HT 5HT 5HT 5HT 5HT Presynaptic Neuron Integral membrane Protein, 5HT reabsorption Synaptic Vesicle Presynaptic Receptors, 5HT exocytosis Synaptic Cleft Ion channels, depolarize postsynaptic membrane Postsynaptic receptors, activate 2nd messenger cascades Coupled Gs protein alpha Mediate cyclic AMP levels Best SNP: HTR7 p=0.0066 OR=1.42 Postsynaptic Neuron

9. Two complementary strategies for identifying genes influencing suicidal behavior The human genome: 23 pairs of chromosomes • Serotonergic Pathway • Genome-wide • Association Study

10. Genome-Wide Association Studies (GWAS) • The goal of our attempted suicide GWAS was • to compare genetic variation inbipolar suicide • attempters and bipolar non-attempters • Our attempted suicide GWAS incorporated genetic • information from 2.4 million SNPs located • throughout the genome. • SNP allele 1: AACGGT • SNP allele 2: AACAGT • Cases: 20% allele G, 80% allele A • Controls: 50% allele G, 50% allele A • The larger the sample size, the smaller the effect that can be detected. GeneChips: screen genome using common DNA markers

11. ACP1 • Acid phosphatase 1 (enzyme) • ACP1 expression is significantly • altered in bipolar subjects who • have committed suicide • ACP1 protein influences the Wnt • signaling pathway, which is • regulated by lithium • Lithium is the primary medication • used to decrease suicidal • behavior in bipolar subjects ACP1 structure (Protein Data Bank)

12. LRRTM4 • We also tested for evidence of sex-specific • attempted suicide risk variants • There was no overlap in the top male and • female risk variant lists • The most significant female risk variant was • located in the LRRTM4 gene • LRRTM4 is located in the part of the genome • previously implicated in suicidal behavior • in major depression, bipolar disorder, and • alcoholism • LRRTM4 is known to help determine the • hardwiring of the brain Linhoff et al. 2009

13. Research Summary • Family, twin, and adoption studies provide strong evidence for a heritable component to suicidal behavior • The heritable component for suicidal behavior depends in part on an association with psychiatric disorders and in part on heritable factors specific to suicidality • Our serotonin pathway study did not support the hypothesis that these genes play a major role in suicide risk • Our genome-wide association study of attempted suicide identified two promising candidate genes: ACP1 and LRRTM4

14. Suicide Genetics Research in the 21st Century • Understand the role that genetics and biology plays in suicidal behavior • Sex-specific risk genes • LRRTM4 • Sex chromosomes • Better treatment options • Determine who would benefit most from lithium • Identification of alternatives to lithium • Larger scale studies • The Psychiatric GWAS Consortium (PGC) • Cross-disorder analyses • Other factors • Determine whether epigenetic modifications play a role in suicide risk • Understand how genes interact with environment to increase risk